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Arterial spin labeling for acute stroke: practical considerations.

Greg Zaharchuk1

  • 1Department of Radiology, Stanford University, Stanford, CA, 94305-5488, USA, gregz@stanford.edu.

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Arterial spin labeling (ASL) offers a non-contrast MRI method for measuring cerebral blood flow (CBF). Advances are making ASL more suitable for acute stroke imaging, but practical challenges remain for clinical use.

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Area of Science:

  • Medical Imaging
  • Neuroscience
  • Radiology

Background:

  • Arterial spin labeling (ASL) is a non-contrast MRI technique for cerebral perfusion measurement.
  • ASL offers advantages like non-invasiveness and straightforward cerebral blood flow (CBF) quantification.
  • Traditional ASL has limitations in acute stroke due to low signal-to-noise ratio (SNR) and sensitivity to arterial transit delays.

Purpose of the Study:

  • To review the evolving role and challenges of ASL in acute stroke imaging.
  • To highlight recent advancements improving ASL's applicability in time-sensitive stroke scenarios.
  • To identify key areas for development to facilitate ASL's clinical adoption in acute stroke.

Main Methods:

  • Review of current ASL techniques and their modifications for improved SNR and reduced sensitivity to transit delays.
  • Discussion of advancements in 3T MRI scanners and velocity-selective ASL sequences.
  • Analysis of practical considerations for optimizing ASL in acute stroke research and clinical practice.

Main Results:

  • Higher SNR ASL implementations and 3T scanners are increasing ASL's utility in acute stroke.
  • Velocity-selective ASL shows promise for quantifying CBF in areas with delayed arterial arrival.
  • Significant practical issues persist, including optimizing the time-SNR-resolution trade-off and sensitivity to slow flow.

Conclusions:

  • ASL is becoming more viable for acute stroke imaging due to technological advancements.
  • Further development is needed in optimizing ASL sequences, post-processing, and automated analysis for clinical integration.
  • Addressing these challenges is crucial for translating ASL into routine clinical trials and practice for acute stroke management.